Heart faces first test of prevention economics

A study at the Journal of the American Medical Association (JAMA) shows risk assessments can be improved 25% by adding a CT scan for coronary artery calcium to current tests. Is this worth it?

It's a cardinal tenet of preventive medicine, and of health reform, that knowing risks is valuable.

That claim is going to get a severe test as the CACS makes its way into the lexicon.

The Coronary Artery Calcium Score (CACS) is measured through X-ray computed tomography, an expensive process that also delivers double the radiation load of a mammogram.

We know the process works. Only last year X-ray CT scans were used to prove Egyptian Pharoahs had heart disease. (Alas, too late to get Boris Karloff into a Lipitor ad.)

Now, a study at the Journal of the American Medical Association (JAMA) shows risk assessments can be improved 25% by adding this test to the normal round of cholesterol tests, blood pressure, waist size and body mass index through which doctors now decide whether "the big one" is coming for you.

CT scans can cost anywhere from $700 to $3,000, depending on the facility you go to, and CACS tests are not usually covered by insurance. By contrast, I was able to quickly find labs selling cholesterol tests for just a few hundred dollars, and such tests are often covered by insurance with a co-pay of less than $50.

In the JAMA article, about 6,800 people from a study on atherosclerosis were divided in two, with those having diabetes tossed out. Half got the usual risk assessment -- age, sex, tobacco use, blood pressure, drugs to control it, cholesterol, and race. The other half added the CACS test. Over the course of nearly six years, the CACS test improved risk assessment by about 25%.

The question occurs, is that increase in accuracy enough to justify the expense of the test? For well-off patients who can afford it, perhaps it is. It's doubtless worthwhile for Goldman Sachs to get one of these for CEO Lloyd Blankfein.

But what about ZDNet writer Dana Blankenhorn? I'm 55, I take drugs for both cholesterol and hypertension (without which both would be off the charts), and while I don't smoke my dad had a heart attack in his 40s. What's the cost-benefit for this patient of a CACS test?

It's that cost-benefit question that becomes important. Insurers conduct such tests all the time. Maybe they would say no. But might government now say yes? And what does that do to the nation's health care bills, when my test is multiplied millions of times?

Before this gets political, the situation now is most insurers say no, and if you can't afford the test on your own it's too bad. But if the cost-benefit of CACs is proven -- if it extends life and lets doctors concentrate on high-risk cases -- will that change anything? Because whatever the benefit there is still the cost.

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